Not sure what to do

[love_of_sunflowers]

I really don't know what to do. I have been a public health nurse for the last 3 years, the longer I am there the more I really dislike it. I work for a very small county health department and we wear multiple hats-it is myself and one other nurse. I took the position mainly because of the hours and the flexibility it gave me to care for my mom. She passed in December. I have been considering a job change for quite some time. I really miss patient care. I am currently only part time- but since COVID hit- I have been working 7 days a week and doesn't appear to have an end in sight. Just for the heck of it I applied at a local nursing home, within the hour of applying on Indeed I received a call from the D.O.N. We chatted for my entire lunch break. I am not looking to change jobs for the money, although what I was offered it is definitely worth considering. I was offered $5 an hour more than what I currently make, would be working 12 hour day shift (3 days one week, 4 the next) every other weekend and a $4,000 sign on bonus. I am just afraid to take the position and totally fail. I have not worked as an RN in a long term care setting and have also been away from direct patient care for 3 years, would I be able to catch on? Would my skills come back? Is it worth a try or should I remain miserable where I am at currently? What would you do? 

[Nurse SMS, MSN, RN]

Ask if you can come in and shadow for five or six hours. That will tell you a lot of what you need to know. There are good places and bad places. Spend a little time there. Does it smell like stool/urine? Are the residents clean and cared for? Is there a solid routine for dealing with issues? Do the coworkers start telling you to watch out for so and so or do they get along? Is the DON visible? Are physicians easy to contact and collaborative?

[Lovethenurse2b25, ASN, BSN, CNA, LPN, RN]

A while nurse once told me to stand clear of longterm care jobs that offer a big sign on bonus. These facilities usually have a high turnover rate and terrible staffing issues. 

[amoLucia]

SMS - thanks for adding to my suggestions. I also would say to check out mealtimes, esp for avail of staff to assist residents and to check out the quality of the meals served.

Lovethenurse - usually I would agree with you re turnover & staffing. But in these crazy C19 times, ALL BETS ARE OFF!  Soooo many facilities & agencies are facing staffing issues. I'm giving the facility the benefit of the doubt!

OP is not happy where she is and has an opportunity to try something else.

[Hoosier_RN, MSN]

Many keep mentioning shadowing. Many LTCs are closed to the public and won't allow shadow, so depending on what local facilities may be doing, it may not be feasible 

[kbrn2002, ADN, RN]

21 hours ago, love_of_sunflowers said:

Thanks for all the replies. I am still considering going to long term care. There is another facility very close. Also a sign on bonus, 3 shifts a week 9a-9p, I have worked as a CNA at both options many many years ago. What are some questions that I should be asking the DON's that would help me make a decision? 

Assuming you already have offers from both then it's time to start asking questions about pay/benefits.  Especially benefits if you need employer provided insurance, the insurance offered through my previous employer was pretty awful. While there's no wiggle room in negotiating those types of benefits you are probably in a better position to negotiate a higher than initially offered wage than you think.

What's the PTO accrual rate and what is the policy on actually using it? My former employer wouldn't allow weekend PTO without finding your own replacement until you've been there three years though I do think they recently changed that to a one year requirement.  If you want more than one weekend a year you were responsible for finding your own replacement unless you've been there at least five years which I think they may heave reduced to the three year mark as well. Sorry for rambling on about this, point is some facilities have ridiculous PTO policies in place that make it almost impossible to use or that force you to use it for any time off you take including sick time.

Ask how the sign on bonus is paid out, it's typical to pay it in chunks with the final payment at the end of one year employment or in some cases paid in full after one year. Rarely is it paid in full up front, if it is ask if there is a repayment penalty if you leave before a year. 

Beyond pay also ask about staffing and more importantly watch the floor if you have the opportunity to see if the facility looks decently staffed. No guarantees the DON won't blow sunshine up your butt about how well they are able to maintain staffing on a day to day basis. 

Specifically ask what their policies are to fill a call-out as mandated OT  is often the go-to solution. If the place mandates for coverage expect if you accept the position that they will mandate more often than they are likely to admit to during an interview process.  

Also while it seems like it doesn't directly affect your job the CNA staffing most definitely does affect how difficult your job can be. Ask what the staffing ratio is for CNA's and how they fill open CNA holes in the schedule. 

Keep in mind the DON will most likely have zero problem being less than honest with answers to questions about staffing.  She/he can't really blow too much smoke up your butt with an offer that doesn't materialize though it's not impossible for them to come back with a lower than initially  offered wage with the excuse "corporate" wouldn't approve the wage. In that case don't settle. Run, don't walk from any LTC facility that blames all their decisions on "corporate" right from jump. If they start invoking the never seen corporate as their scapegoat for decision making before you even start working there believe me it won't get better.

[Crystal-Wings, LVN]

If they’re offering a bonus that is a big red flag. They probably have extremely high turnover and poor staffing ratios. 

[amoLucia]

Even with limited C19 visiting, the DON might arrange for something if it's believed that OP might really be interested.

PP kbrn made GREAT, GREAT comments esp about CNA staffing, callout coverage and 'corporate' blaming.  

I realize that we well seasoned, experienced senior & LTC/SNF nurses have a fine-tuned internal barometer on how to check out these situations. Like a sixth-sense! For a newbie nurse and who's unfamiliar with LTC, it is MAJORLY difficult and different for one to get a grip on these types of situations. We all have our own perspectives.

What more can be said except to say good luck to you, OP.

 

[Hoosier_RN, MSN]

5 minutes ago, amoLucia said:

Even with limited C19 visiting, the DON might arrange for something if it's believed that OP might really be interested.

PP kbrn made GREAT, GREAT comments esp about CNA staffing, callout coverage and 'corporate' blaming.  

I realize that we well seasoned, experienced senior & LTC/SNF nurses have a fine-tuned internal barometer on how to check out these situations. Like a sixth-sense! For a newbie nurse and who's unfamiliar with LTC, it is MAJORLY difficult and different for one to get a grip on these types of situations. We all have our own perspectives.

What more can be said except to say good luck to you, OP.

 

And most of us have a friend or 2, or know someone at each facility, so we hear how things are 

[kbrn2002, ADN, RN]

15 hours ago, Hoosier_RN said:

And most of us have a friend or 2, or know someone at each facility, so we hear how things are 

Good point there. When considering accepting  a job this is one of the rare situations it's a good thing to listen to the gossip! While horror stories about a facility might be somewhat exaggerated there's a kernel of truth in there so if you hear nothing but negative be very wary about accepting. 

[FolksBtrippin, BSN, RN]

Where I live, it is very difficult for LTCs to hire and keep RNs. 

A quick offer is to be expected with many nursing positions because there are not enough of us. And you are an experienced nurse. It's not surprising they would jump on this and not necessarily a red flag, but LTC is very tough.

Think about what you want. There are probably many options for you with public health experience.

[Lovethenurse2b25, ASN, BSN, CNA, LPN, RN]

On 9/2/2020 at 3:39 PM, Lovethenurse2b25 said:

A wise nurse once told me to stand clear of longterm care jobs that offer a big sign on bonus. These facilities usually have a high turnover rate and terrible staffing issues. 

 

[amoLucia]

FolksBtrippin - exactly what I was trying to get across!